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HomeMy WebLinkAboutForm 460 - Randy Warren for City Council 2013 (2013-10-19) AmendmentReciient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) Type or print in ink. Statement covers period from 9/22/2013 SEE INSTRUCTIONS ON REVERSE through 10/19/2013 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee F-1 Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Part 5) 0 Sponsored MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX (Also Complete Part 6) F-] General Purpose Committee 0 Sponsored F-] Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D.NUMBER 1 1359636 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Randy Warren for City Council 2013 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94903 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX PO Box 6285 CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94903 OPTIONAL: FAX / E-MAIL ADDRESS Date Stamp Date of election if applicable: Page 1 of 8 (Month, Day, Year) For Official Use Only 11/5/2013 2. Type of Statement: F-1 Preelection Statement Quarterly Statement F-1 Semi-annual Statement F-] Special Odd -Year Report F-1 Termination Statement F-] Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 Amendment (Explain below) Correction of math error in totalling expenses paid and corrected summary page line 13 to show amount in A3 instead of A5 Treasurer(s) NAME OF TREASURER Sue Ellen O'Brien MAILING ADDRESS PO Box 6285 CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94903 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the)aws of9' )e State of California that the foregoing is true and correct. T Executed on By Date Signat ag&er or A 1-stant Treasurer Executed on By 006 Date Signature of ContL 5 ,giOffi�eho der, Can �dic[6'te State Measure Proponent or Responsible Officer of Sponsor Z" Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) State of California Type or print in ink. Recipient Committee tement Campaign M Cover Page — Part I 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE RANDY WARREN OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) CITY COUNCIL, CITY OF SAN RAFAEL RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP SAN RAFAEL CA 94903 Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? C} YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION COVER PAGE - PART 2 Page 2 of 8 F-1 SUPPOR - O..O Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD [] SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD SUPPORT OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD E] SUPPORT OPPOSE FPPC Foran 460 (Januaryl05 FPPC Toil -Free Helpline: 866/ASl -FPPC (866/275-3772) State of California Campaign Disclosure Statement To calculate Column 13, add amounts in Column A to the corresponding amounts from Column B of your last Type or print in ink. 0 SUMMARY PAGE Summary Page 8,905 Amounts may be rounded to whole dollars. 0 Statement covers period 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ 37660 $ 8,905 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 0 0 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 0 0 11. TOTAL EXPENDITURES MADE ................................Add Lines 8 + 9 + 10 $ 3,660 $ 8,905 9/22/2013 from through 10/19/2013 Page 3 of 8 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER RANDY WARREN 1359636 Column A Column B Calendar Year Summary for Candidates Contribut"lons Received TOTALTHIS PERIOD ATTACHED SCHEDULES) CALENDAR YEAR TOTALTO DATE Running in Both the State Primary and (FROM General Elections 1. Monetary Contributions .......................................... Schedule A, Line 3 7 824 $ 7 $ 14 368 , 17000 1/1 through 6i3© 7/1 to Date 2. Loans Received ...................................................... Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines I + 2 $ 7,824 $ 15,368 20. Contributions Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 999 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ 8,823 $ 15,368 Made $ $ Expenditures Made To calculate Column 13, add amounts in Column A to the corresponding amounts from Column B of your last 71824 0 6. Payments Made ....................................................... Schedule E, Line 4 $ 3,660 $ 8,905 7. Loans Made ............................................................. Schedule H, Line 3 0 0 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ 37660 $ 8,905 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 0 0 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 0 0 11. TOTAL EXPENDITURES MADE ................................Add Lines 8 + 9 + 10 $ 3,660 $ 8,905 Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 13. Cash Receipts ................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash ........................... Schedule /, Line 4 15. Cash Payments .................................................. Column A, Line 8 above 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ 11734 To calculate Column 13, add amounts in Column A to the corresponding amounts from Column B of your last 71824 0 39660-1 i report. Some amounts in Column A may be negative figures that should be subtracted from previous 57898 period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and any). I Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (if Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A Monetary Contributions Received Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 9/22/2013 SCHEDULE A SEE INSTRUCTIONS ON REVERSE through 10/19/2013 Page 4 of 8 NAME OF FILER LD. NUMBER RANDY WARREN 1359636 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ®IND 9 22 1 / / 3 Jody Morales F] COM retired 100 109 OTH San Rafael CA 94903 ❑ PTY LSCC ®IND IND 1 2/13 0/ Deke Welch retired 200 200 ❑ OTH San Rafael CA 94901 ❑ PTY F-1 SCC ®IND 10/18/13 Carolyn Lenert O Com Realtor 400 400 oTH F-1OTHPinel Realtors San Rafael CA 94903 2 PTY F1 SCC ®IND 10/7113 Edmond McGill ❑COM Attorney, McGill Law 100 100 ❑ OTH Office Novato, CA 94949 ❑ PTY ❑ SCC Art Faibisch ®IND COM Opinion researcher, 10/14/132 -OTH ADF Research 300 300 San Rafael CA 94901 Q PTY ❑SCC SUBTOTAL $ 13100 Schedule A Summary *Contributor Codes 1. Amount received this period - itemized monetary contributions. IND --Individual (Include all Schedule A subtotals.)........................................................................................................ 71570 COM - Recipient Committee (other than PTY or SCC) 2. Amount received this period - unitemized monetary contributions of less than 100 ............................. 254 OTH�- other (e.g., business entity) PTY Political Party 3. Total monetary contributions received this period. 7 824 SOC - Small Contributor Committee (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ....................... TOTAL FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period 1 , to whole dollars. FORM 460 from 5 8 10/19/2013 through Page of NAME OF FILER I.D. NUMBER RANDY WARREN 1359636 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) GODS (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS} F-1 IND Fulcrum Test Preparation & Admissions 10/15113 Solutions, Inc. ®OTH 490 490 677 Waverly Rd, Palo Alto CA 94301 ❑ PTY F-1 SCC Al Dugan ®IND ❑CO Insurance Executive 10/8/13 ❑ OTH 80 280 Novato CA 94947 ❑ PTY ❑ SCC Committee To Recall Susan Adams ❑ IND ®COM 10/18/13 ❑ OTH 17000 17000 San Rafael CA 94903 ❑ PTY ❑ SGC Richard Lawrence ®IND ❑COM Fund manager 10/15/13 ❑ OTH Overlook Investments 47900 47900 Kentfield CA 94904 ❑ PTY ❑ SCC F-1 IND ❑ COM F_]OTH ❑ PTY ❑ SCC Codes IND — Individual Recipient Committee (other.. PTY or business Political _aUAU_C'_ftkLd11L• ! SUBTOTAL $ 61470 FP P Form 460 • Toll-FreeHelpline:866/ASK-FPPC(866/275-3772) Schedule C Type or print in ink. SCHEDULE C Amounts may be rounded Nonmonetary Contributions Received to whole dollars.CALIFORNIA Statement covers period 460 9/2212013 1FORM from 0 $ 10119/2013 through Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER RANDY WARREN 1359030 DATE FULL NAME STREET ADDRESS AND R CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT/ FAIR MARKET CUMULATIVE TO DATE PER ELECTION TO DATE RECEIVED ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) GOODS OR SERVICES VALUE CALENDAR YEAR (JAN 1 - DEC 31) IF REQUIRED ❑IND❑COM 10/1/13 Warren Law Group PC campaign signs 999 999 4040 Civic Center Drive Suite 200 �OTH San Rafael CA 94903 ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC T IND ❑ COM ❑ OTH PTY SCC ❑IND ❑ COM ❑ OTH T PTY ❑ SCC --------------------- -------------- ------------------- Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ ---------- - ---- Schedule C Summary 1. Amount received this period — itemized nonmonetary contributions. (Include all Schedule C subtotals.)..................................................................................................................... *Contributor2. Amount received this period — uniternized nonmonetary contributions of less than $100 .................................... $ 3. Total nonmonetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ...................... TOTAL $ .. E — Individual ! Recipient • (other than PTY or SCC) i ! • business PTY — Political Party SCC — Small Contributor Committee i • • Schedule E Payments Made Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 9/22/2013 SEE INSTRUCTIONS ON REVERSE through 10/19/2013 Page 7 of 8 NAME OF FILER I.D. NUMBER RANDY WARREN 1359636 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants IVITG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Amity Press rubber stamp 41 55 Mitchell Blvd #11 San Rafael, CA 94903 Citibank bank fee Northgate Drive 10 San Rafael Registrar of Voters voter list 24 Civic Center * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 75 Schedule E Summary 1. Itemized payments made this period. (include all Schedule E subtotals.) ............................................................................................................. $ 3,660 2. Uniternized payments made this period of under $100 .......................................................................................................................................... $ 3. Total interestpaid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ............................................................................... $ 0 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............................. TOTAL $ 3,000 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule E Type or print in ink. (Continuation Sheet) Amounts may be rounded Payments Made to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER RANDY WARREI Statement covers period frnm 9/22/2013 through 10/19/2013 0 I.D. NUMBEi III�IR 1359636 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRIC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Target Marketing USA 22981 Calle, Azorin Mission Viejo CA pho 447 Take 1 Marketing P.O. BOX 16322 lit 3,000 Sacramento CA 95816 Warren Law Group PC PO Box 6285 CMP 138 San Rafael CA 94903 Oil! FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)